Anorexia nervosa is the best known of a range of illnesses classified as eating disorders. Anorexia nervosa literally means 'loss of appetite for nervous reasons'. The main diagnostic criteria for anorexia is that there is a weight loss leading to a body weight of at least 15% below the normal weight for height or age, although anorexia itself is much more complex than just loss of appetite or weight loss. Those with anorexia will deliberately starve themselves until they are very ill, and in a small number of cases until they die. Anorexics are terrified of gaining weight and if they feel they have eaten even a tiny morsel too much they will exercise obsessively to get rid of the calories. They are often obsessed with the amount of calories in each type of food. They will often encourage those around them to eat more, whilst continually cutting back on their food intake. Anorexics desperately want to be in control, and the one thing they feel they can control is their food intake. Sadly they soon find that they have lost control and that their anorexia is controlling every aspect of their lives. When he was well on his way to recovery Joe said to me, "Mummy, I just wanted to lose a bit of weight for my sport and it just got completely out of control."
But anorexia is much more than just being about food. The sufferer is normally deeply unhappy about some aspect of his life and will have a very low self-esteem. Many sufferers feel that their illness gives them the attention from their loved ones that perhaps they felt they weren't getting before. Finding out what has made the sufferer unhappy or craving attention can be very difficult and sometimes impossible to work out. There are literally hundreds of reasons why young people suffer from anorexia nervosa. The most important thing to remember is to look forward, not back. Often the cause is irrelevant to the recovery and most anorexics do eventually recover.
What are the effects of self-starvation? A period of sustained weight loss and malnutrition will result in the patient suffering from many symptoms, and damage can be severe. There are many symptoms of anorexia and not every patient suffers from all of them. I mention some of the more common symptoms below and you will find that the more you read, the more symptoms you will discover. It may well be worth alerting your son as to what could happen to his body if he continues to lose weight and be malnourished over a long period of time.
The short-term effects of anorexia are usually apparent fairly early on. In girls, as well as periods stopping, their ovaries and uterus may start to shrink, and growth in general stops. In boys you don't have such a clear indicator as loss of periods, but ongoing puberty may be arrested or slowed down, and your son may revert to a more childlike state. This is certainly what happened with Joe. As he lost weight he looked younger, he spoke more quietly and became much less physically active. Many anorexics quickly become depressed, may suffer from poor concentration and lose powers of memory. They may also become irrational and unreasonable as a result of subtle changes to the balance of chemicals within the body, and most will suffer from a feeling of low self-esteem. Some develop an unsightly fine downy hair on their back and face called lanugo. It is one of the body's ways of keeping warm. Muscles may become weak after a period of malnutrition and major nerves can become prone to pressure damage. The heart starts to pump less efficiently and this often leads to an abnormally low pulse rate and blood pressure. This in turn causes dizzy spells and the sufferer constantly feels cold and tired. A poor diet may also lead to anaemia, which also causes tiredness and the sufferer becomes very pale. A poor diet may also lead to constipation, a feeling of bloatedness, and stomach pains, which can be severe. Joe had episodes when he lay curled up on the ground screaming in agony, having eaten just a few morsels of food. All of these effects reverse quite quickly once normal eating patterns are resolved.
The long-term effects of anorexia are not so obvious, but can be of greater concern. In girls long-term loss of periods can lead to infertility, and the abnormally low hormone levels can lead to osteoporosis, resulting in bones that are weak and can fracture very easily. Other hormones such as thyroid and growth hormones can also be affected by long-term starvation. The reduced hormone levels have similar effects in boys in terms of infertility, bone density, growth etc. Internal organs are inevitably affected by a lengthy period of starvation, and in particular the heart and kidneys may suffer irreversible damage. Circulation of blood around the body can also be dramatically restricted, following a lengthy period of malnutrition, and in severe cases this can lead to tissue death in the extremities. Many long-term anorexics have suffered from gangrene and some have needed below the knee amputations. Unfortunately some anorexics die but thankfully the percentage is quite low. Some can no longer cope with their illness and take their own life, others die from organ failure, but I must stress these are very extreme cases. Many anorexics recover and live perfectly normal lives. Many learn to live with their anorexia.
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